Homestead_YoungbloodL
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (132 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM AR
HC70
CERTIFICATION STATEMJkNj
I r e) _ _ _ _ entfy � ton the 1 day {yf'Ma "r'ch ", 19
�) occupied as our principal place of residence the folio ing descri real prop y or which a Homestead rope y, Pig claimed:
(We) owned ❑ Are buying under contract ri �{
=Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owners name -
Recorder's o "ice where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (c� ,own, township)
r bar
-Oo 02, 0
Legal description '
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
County Township
I ITownship
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Seby certify the above statements are true, correct and complete.
Signature of claimant
(2)
ess (number and street. city. state. ZIP code)
I Y
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
V�r1g action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
STANDARD
3
xlAnt tORM!JteliR_/t-n, 1RFASURTI FORM 11A
.APPRIWEn BY ST\TEBMRDItF MVttJ.\TS.2am PIIYAIarpoYTI[DEP. t% NTUF LOCAL rAvrtNMrNt rm:A\'cEtf.-1.1-i'-r.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
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HEA 1344-2009 requires taxpayers•who receive the homestead standard deduction to verity that they are eligible to teethe the
benefit and to provide additional identifying infomunwn necessary to allow county go eminent to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance vs.ill use this information to create/cola that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address -
Youngblood, Rodney/:Nicole l b 217 a A, _.'�Aa>
_LlQ.L.ta uric
Somerville IN 47683
6446
Rodney/Nicole Youngblood
PO Box 353 State Parcel Number Legal Description
Somerville IN 47683-0353
irirriirt ririirrirrirrriit•. .•rri tier riirririr rriirr rim 26-20-02-402-000.262-003 020-00262-00 OLD PLAN2PT
PART 2: TAXPAYER INFORMATION
Owner I 1 First Middle 'Last
ktne� �DUn9blo
tg Address(number and street,city,state,and ZIP code) - ❑ Same as property address-— --- -— -- — --
l�.n.51th, � Soo r r, //t) -I-10 0 4- 1lfl 3?
Spouse First Middle Last
\ cotta 1S t/1\01A nsblpm/
Mailing Address(Number and street,city,state,and ZIP code) Same as properly addles
�.D?o&353 Sot - rv:LCe )trI4 '/bS3
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date I
PART 4:ADDITIONAL INFORMATION
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